Cardiovascular Drug Introduction Cardiovascular medications can be broken down into the following categories Antiarrhythmics Antihypertensives Inotropes Vasodilators Diuretics Antihyperlipidemics Anti-plateletes Thrombolytics Hypertension with Concomitant Diseases Essential hypertension diuretics high doses can lead to orthostatic hypotension hyponatremia and hypokalemia with increased urine Na+ and K+ concentrations ACE inhibitors/ARBs calcium channel blockers peripheral edema is a common side effect direct renin inhibitors CHF diuretics K+-sparing diuretics (eg. spironolactone) ACE inhibitors/ARBs may use ARB if patient fails ACE-I therapy contraindicated do not use β-blockers in uncompensated patients Diabetes mellitus diuretics ACE inhibitors/ARBs added benefit of ↓ risk of diabetic nephropathy calcium channel blockers β-blockers mechanism of action includes block of catecholamine-induced renin release by the kidney use cardioselective (β1 selective) drugs to avoid bronchoconstrictive effects (e.g. metoprolol) α-blockers (-zosin's) Pregnancy methyldopa hydralazine labetolol contraindicated do not use ACEIs/ARBs due to teratogenicity COPD/Asthma calcium channel blockers contraindicated do not use β-blockers due to potential bronchoconstriction Benign prostatic hypertrophy α-blockers can treat both BPH and hypertension at same time Post-MI spironolactone calcium channel blockers β-blockers Treatment of Malignant hypertension Nitroprusside ↑ cGMP via direct release of NO results in ↓ TPR in venules and arterioles cyanide toxicity treated with nitrites + sodium thiosulfate Fenoldopam dopamine D1 receptor agonist preferentially ↑ flow in renal vasculature preserves blood supply of kidney note: fenolDOPAm Diazoxide K+ channel opener results in hyperpolarization of arteriolar smooth muscle ↓ TPR ↓ insulin secretion resulting in hyperglycemia